HomeMy WebLinkAboutCertificate Of Capacity- Zoning ComplianceY V
DATE FILED: %�j�
PLAN REVIEW FEE: 0'D RECEIPT NO.: -_awls. PERMIT NUMBER: K , V O 422
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
JST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Pie Virginia Avenue elect. /p Jew
Ft. Pierce, FL 34982-5652 II n
772-462-1553 r'o* W,9e
SwbS
APPLICATION for BUILDING PERMIT M ,•,�
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION 41 0z)
1. LOCATION/SITE ADDRESS:1�1Ie. 1� ► ��� i� - Zy��, rZ 3 �
2. PROJECT NAMES ?}�pJ�t ISkO SITE PLAN NAME:
3. PROPERTY TAX ID #:�-��-
4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): L444,9 Ly'; r4e N PA27 o;- s','-ram; 914 2 TuJY 346
_<6070-, XA-r44E- 39 5AS� 67. L✓G:F_ cou ��f-L 20w4:1)Aey::yl
5. PLAT BOOK 4�'j 6. PAGE NO. ZS 28" 2 <e 7. BLOCK NO. 24 8. LOT NO. G.
9. PARCEL SIZE (ACRES/SQ FT.): 16.) 3 Acai" LOT DIMENSIONS: J;E£ iWO_J�ka� € -)ORO so'evs-j+
m
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: 4-�..57R-yGT dd oi-r A-
11. SETBACKS (ACTUAL) FRONT: NA BACK: N .A- RIGHT SIDE:' N A- LEFT SIDE: NA
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
pQ NEW CONSTRUCTION [X] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL .COMMERCIAL [ ] .INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: zA.SS tit3L,/
14. SQ. FT OF CONSTRUCTION: 4?,2 yi-(/ Lc) C 15. SF. FT 1st FLOOR: 3 34�5
16. VALUE OF CONSTRUCTION: $ _3. Gb4 , coo
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the valueis $2500 or more, a
RECORDED Noficc of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME•. f2�S�� ✓�
ADDRESS: I9 i 4
CITY: P6a:)— L = STATE: FL ZIP:
PHONE (DAYTIME): (;Y G l 461— l 3nt, Email: J'Y£g-2y @ PG ki4 . coarl
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): (_-)
CONTRACTOR INFORMATION
ST. of FL REG. CERT #: 4�4 C 15 19 413 ST. LUCIE COUNTY CERT #: 2-6
BUSINESS NAME: J-4 0W.,!C i gdc- 7 o nJ
QUALIFIERS NAME: .l.,EO 1Po L I-YO �i v
ADDRESS: I 10 S 2 N� �
CITY: Kn - 9 i saxl-f— ~"� STATE: L ZIP: 9 O
PHONE (DAYTIME): ( - �2� - O(Y'-� FAX NO. Email: ► C! J
f�i$V�w�I�SS � lar914i �. �r'1
ARCHIT/ENGINEER: rl e-cicA.5 0+ £e,i! r-1 4 ebV rC
ADDRESS: 7,:� 4-is- �i $ i F— � ►z le W 1
CITY: J.Ae-k'.�0;4'✓; L°'z STATE: ZIP: 3Z2S
PHONE (DAYTIME): "o 731 - 23Z3
BONDING COMPANY:
ADDRESS:
CITY: STATE: ZIP:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE: ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full eoncurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
SIGNATURE
STATE OF FLORIDA STATE OF P
COUNTY OF ST• L) CIE COUNTY OF
The foregoing instrument was acknowledged before
we this ag day of (�) WC-h 20 (� ,
by 31 mrn.J
who is personally known t✓ or has produced
142
The foregoing instrument was acknowledged before
me thisC�0) day of 20A
by
who is personally known or has produced
as identification. I as identification.
Signature of Notary Signature ry
E.SCHWER 2 O (Seal)
Commission No.�E T`4�'" (�ISSION it EE 847629 Commission No. �a �l (
� EXPIRES: January 7, 2017
!lf�1�• Wed TfwNo" Public Underwriters
*N Av so14c+ IV,
Public State of Florida
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE IV, AjU iW JrOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST E ALWeAIWA(R6;To SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF' A
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. '
For specific il0tructions see appropriate permit c`thecklist. 4 .
I i
OFFICE USE ONLY. L �' #: /90 0-y bR ,
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1 ST FLR ELV
MAX HOT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
.IMPACT
IMPACT FEE
IMPACT
PEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
D
CREDIT
Y
N
LAW ENF
IMPACT
CT
FE
IMPACT
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
�—
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLL
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
,
COMPLETED
INITIALS
,
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